Healthcare Provider Details

I. General information

NPI: 1508495847
Provider Name (Legal Business Name): MR. EVAN CHRISTOPHER HAKMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 W EVERGREEN AVE STE 200
EFFINGHAM IL
62401-1638
US

IV. Provider business mailing address

1005 HEALTH CENTER DR STE 201
MATTOON IL
61938-4653
US

V. Phone/Fax

Practice location:
  • Phone: 217-342-3400
  • Fax: 217-342-6417
Mailing address:
  • Phone: 217-868-2812
  • Fax: 217-258-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.008196
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: